The common bile duct exploration (CBDE) is a common surgical operation for treating gall-stone, bile duct narrowing and related complaints. In CBDE, a longitudinal incision is made in the common bile duct (CBD) and sutured after the operation. Since simple suturing often includes bile leakage or bile duct narrowing, and thus causes further complications, in clinical practice a T-tube is usually inserted to provide a support during the operation and to keep the bile duct open afterwards. Bile or other secretions can either flow into the intestine through the bile duct or flow out through the long arm of the T-tube fixed in an opening in body wall, thus avoiding complications due to bile duct narrowing or cholestasis. The combination of fitness between the T-tube and the bile duct wall, and the effective suturing will generally prevent the leakage of bile through the incision. The T-tube is removed 2 weeks after the operation, after the sinus formation around the tube.
The insertion of the T-tube may sometimes lead to complications: (1) it may cause an inflamatory reaction, leading to swelling and narrowing of the bile duct; (2) it can induce bile duct infection caused by the counterflow action through its long arm or the infection around the drainage exit at the abdominal wall; (3) if the outflow of bile from the long arm of the T-tube approaches 300–800 ml/day, water-electrolyte disorders and acid-base imbalances occur. This may interfere with the normal mobility of intestine and inhibit the recovery of digestive functions; and (4) if the T-tube is left in position for an extended period it may cause pressure on the surrounding tissues and organs, possibly leading to perforation and adhesion. Furthermore the sinus may not form properly or even break when the T-tube is removed and bile leakage may occur. Alternatives to the T-tube include alternative stent designs such as “C tubes” and the like. All these methods necessitate leaving a stent embedded in the patient's body for about 2 weeks before it is manually removed. In some procedures the stent is inserted through the duodenum, and is moved out from the bile duct into and through the intestine taking advantage of the peristalsis and contraction of the bile duct sphincter. In such procedures it is very difficult to control the time and speed of transfer of the stent to the intestines and the procedure is thus difficult to be adopted clinically.
Liver transplantation is performed to save the patients suffering from serious liver diseases. The operation involves cutting the CBD and suturing the CBD of the donor liver to that of the recipient. The success of liver transplantation depends heavily on the successful joining of the both CBDs. Because of the orientation of cutting and suturing, there is a high risk of bile leakage and bile duct narrowing. Generally a T-tube is required with its associated risks of complications.
The CBD and pancreas duct have a common exit in the duodenum, so some patients need a reconstruction of the common bile duct to perform a pancreatic operation. This is needed to avoid the risk of bile leakage and bile duct narrowing.